FIELD OF THE INVENTION

The invention relates to the identification of a combination of reagents that prevent the thermal coagulation of proteins in a sample during heating. The use of these reagents allows the direct input of plasma or serum into a thermal cycling reaction without the aggregation of proteins.

BACKGROUND TO INVENTION 1.1. introduction

In the clinic, rapid and specific diagnosis of an infection is fundamental to directing successful treatment. Thermal cycling reactions facilitate diagnosis by enabling the efficient analysis of the nucleic acid in a sample. The polymerase chain reaction (PCR), for example, is a thermal cycling reaction that is used to amplify nucleic acids. PCR uses a series of DNA melting, annealing, and polymerisation steps at different temperatures to greatly 'amplify' the amount of DNA in a sample, allowing detection of sequences that may otherwise be present in the sample at very low levels. Sequences may be detected by use of labelled probes or by determining thermal hybridisation. Other thermal cycling applications are also known.

Efficient PCR requires unhindered interaction between PCR reagents and the nucleic acid target. Burdensome sample processing is therefore often necessary to remove components of a sample that may hinder these interactions. During PCR, for example, it is necessary to heat the sample and PCR reagents to temperatures sufficient to cause denaturing of many proteins found in patient sample and aggregates of these denatured proteins can then inhibit the PCR. It is well documented, for example, that heating plasma or serum to temperatures greater than 60°C induces the protein constituents to aggregate together and form a solid gelatinous mass that inhibits a thermal cycling reaction ^{1 ,2} . Additionally, it is often necessary, as part of a diagnostic assay, to release genetic molecules by protease digestion of cellular, viral or bacterial structures ³ . The necessary protease must then be heat-inactivated to prevent it from inhibiting the thermal cycling reaction. Consequently, it is often not possible to directly input a diagnostic sample into the PCR reaction without a number of prior processing steps. To eliminate the possibility of contaminating proteins, it is therefore conventional practise to purify the DNA/RNA from a plasma or serum sample for subjecting it to a diagnostic Nucleic Acid Test (NAT) comprising a thermal cycling reaction. The use of thermal cycling reactions for rapid and specific diagnosis is therefore limited by the presence of proteins in a sample, which may coagulate the sample during necessary processing steps, or increase the risk of coagulation during the thermal cycling reaction itself. There are a number of additives and agents used to prevent protein aggregation and sample coagulation in other contexts. However, these have not been used in thermal cycling reactions, given that many anticoagulants and anti-aggregation agents are also known or suspected to be potent PCR inhibitors.

1.2. Anti-aggregation and coagulation additives

Anti-aggregation additives are widely used to assist protein expression and refolding in heterologous systems and to prevent coagulation of protein rich sample ¹ , reviewed by Hamada et al. ⁴ and Chi et al ⁵ . Anti-aggregation additives include direct inhibitors of protein aggregation such as amino acids (e.g. arginine, proline, lysine, glycine) ⁶ , polyamines (e.g. putrescine, spermidine and spermine), detergents (e.g. sodium dodecyl sulphate (SDS), Tween 8 ⁷ , Tween 20 ⁸ , Nonidel P-40 ⁹ ) and denaturing agents (e.g. guanidinium hydrochloride (GuHCI) and urea ¹⁰ ). Anti-aggregation additives also include agents that increase the stability of the native protein confirmation, such as sugars (e.g. sucrose, glucose, lactose, mannitol, sorbitol) ¹¹ , poly-alcohols and ammonium sulphate ¹² .

The appropriate type and concentration of an anti-aggregation additive can be optimised for different protein species and for whether the additive is required to assist protein refolding or to prevent sample coagulation ¹³ . Many anti-aggregation additives have only been shown to be effective when they are present as co-solvents, i.e. when they make up a significant fraction of the total mass of a solution (concentrations in the submolar to molar range) ¹⁴ .

1.3. PCR inhibitors

Inhibitors of PCR are many and varied, and include both organic and inorganic, soluble and insoluble substances ¹⁵ . Examples of PCR inhibitors include calcium ions ¹⁶ , bile salts ^17,18 , urea ¹⁹ , NaOH ²⁰ , phenol ²¹ , ethanol ¹⁷ , polyamines (e.g. spermine and spermidine ²² ), polysaccharides ^23,24 , detergents (e.g. SDS), humic acids ²⁵ , tannic acid ¹⁹ , melanin and proteins including collagen, myoglobin ²⁶ , haemoglobin ²⁷ , lactoferrin ¹⁷ , immunoglobin G (IgG) ²⁸ , proteinases and anti- coagulants including heparin ^17,29,30 , sodium polyanetholesulfonate (SPS) ³¹ , EDTA and PCR inhibition can occur by any of a wide variety of different mechanisms ¹⁵ . These include binding, degrading, sequestering, co-precipitating or otherwise modifying the chemical properties of the nucleic acid target ^{21 34-37} , reducing the specificity of the PCR primers ³⁴ , degrading ^{20 38} or inhibiting the polymerase ³⁷ and/or sequestering cofactors of the polymerase ^15,16 . It is therefore difficult and non-obvious to predict whether a particular agent will cause PCR inhibition, at what concentration this inhibition may take effect, and by what mechanism inhibition is caused.

1.4. PCR inhibition by anti-aggregation agents

There is significant overlap between PCR inhibitors, anti-aggregation additives and anticoagulants. PCR inhibition by standard anti-coagulants is well-documented, and present a particular challenge to PCR preformed on clinical samples, given that anticoagulants are often necessary for their collection and preservation, and their inhibitor effects can occur at very low concentrations ²⁹ . Other PCR inhibitors occur naturally in the environment or sample fluid ^25,39 or are required for sample processing (e.g. proteases) ⁴⁰ . Consequently, if an anti-aggregation additive or anticoagulant is used during sample preparation, or is likely to be otherwise present in the sample, it is deemed necessary to extract the nucleic acid from the sample before it may be used in PCR. Given this, and the likelihood of the presence of other potential inhibitors of PCR in a sample, it is standard practise to purify the nucleic acid template before mixing it with the PCR reagents. Furthermore, purification of the template may remove the need for anti- aggregation, given that contaminating proteins and/or protein aggregates will also be removed by purification. Therefore, given that anti-aggregation additives and anticoagulants are often rendered unnecessary by conventional PCR purification protocols, their use during PCR processing has been severely limited. In situations where purification of the template is not otherwise required or desirable, the inhibitory effects of a PCR inhibitor may be mitigated by dilution of the sample ⁴¹ . However, given that many inhibitors of PCR are effective at very low doses ²⁹ , this can significantly reduce the sensitivity of an assay. 1-2% of the anti-aggregate SDS, for example, is required to prevent aggregation of denatured protein, whilst as little as 0.01 % SDS is sufficient to inhibit PCR ³ . Consequently, dilution of the sample to the extent that the anti-aggregate additive no longer inhibits PCR, also abolishes its anti-aggregate effects. It is therefore deemed necessary to purify aggregate proteins from the sample prior to performing the thermal cycling reaction ³ . It is also possible to neutralise the inhibitory effects of some PCR inhibitors by the addition of BSA ¹⁵ . However, BSA is ineffective against the inhibitory effects of anti-aggregate agents such as SDS, calcium and sodium chloride ¹⁵ . In summary, it is known in the field that protein aggregates and coagulants inhibit PCR. Clinical samples often have a high protein content and mixing these samples directly with PCR regents therefore either carries the risk of coagulating the sample during thermal cycling, or necessitates significant dilution of the sample. Clinical samples are therefore purified to extract the nucleic acid before thermal cycling is performed. Furthermore, if an anti-aggregation agent or anticoagulant is present in the sample (either because it is present naturally, or has been added during sample processing), its inhibitory effects are mitigated by purification or significant dilution of the sample.

1.5. Arginine in PCR The use of arginine in PCR has been previously shown. US 2012/0258500A1 uses arginine, and other additives, to improve the specificity of nucleic acid amplification and reduce polymerase inhibition. Similarly, WO 2012/138417 discloses the use of an agent, including arginine, spermidine and/or spermine, at concentrations between 1 and 100mM. US 2005/0277121 also discloses the use of amino acids such as arginine or glycine, in order to lower the pH of the reaction mixture to reduce cellular nuclease activity that may disrupt RT- PCR or other enzymatic reactions. However, the use of arginine as an anti-coagulant has not been demonstrated in the prior art.

SUMMARY OF INVENTION

The present invention provides an improved method for performing a rapid and efficient thermal cycling reaction. In particular, the invention provides a method for performing a thermal cycling reaction that does not require purification or significant dilution of the sample, wherein significant dilution is that which severely reduces the detection limit of the assay. A dilution that severely reduces the detection limit is one that reduces the detection limit by more than 3, 5, 10, 15 or 20 times. A significant dilution may be, for example, dilution by a factor of 4, 5, 6, 7, 8, 9, 10 or more. The invention is based on the surprising discovery that certain anticoagulant formulations do not inhibit PCR at concentrations at which they are effective as an anticoagulant. The invention provides a method comprising directly mixing an anticoagulant with a sample and the regents necessary for preforming a thermal cycling reaction. The anticoagulant acts to prevent inhibition of the thermal cycling reaction by denatured proteins that may either be already present in the sample or that are produced by the thermal cycling process. The addition of the anticoagulant renders unnecessary the purification of the sample in order to remove proteins and protein aggregates. The anticoagulant may also be directly mixed with the sample to prevent protein aggregation during sample processing, for example during heat-inactivation of a proteinase, without the need for additional purification steps to remove the protein aggregates and/or the anticoagulant prior to mixing the sample with the PCR reagents. The invention also relates to a formulation of the anticoagulant.

In one embodiment, the present invention relates to a method of performing a thermal cycling reaction comprising:

mixing a sample with i) an anticoagulant and ii) reagents necessary for performing a thermal cycling reaction in the sample in the presence of a template, and

incubating the sample under thermal cycling conditions,

wherein the anticoagulant protects the thermal cycling reaction from inhibition by denatured proteins in the sample. The invention also relates to the reagents and kits for use in this method.

In one embodiment, the present invention relates to the use of arginine as an anticoagulant in a thermal cycling reaction, wherein the arginine prevents coagulation of protein in the sample resulting from heating. Preferably, the thermal cycling reaction is PCR and preferably arginine is used at a concentration of 2-6mg/ml, more preferably 5mg/ml.

ABBREVIATIONS

BSA bovine serum albumin

CSF cerebrospinal fluid

DNA deoxyribose nucleic acid

EDTA ethylenediaminetetraacetic acid

GuHCI guanidinium hydrochloride

HCV hepatitis C virus

MgCI ₂ magnesium chloride

NAT nucleic acid tests

PCR polymerase chain reaction RT-PCR real-time PCR

SDS sodium dodecyl sulphate

IgG immunoglobin G

DETAILED DESCRIPTION

Brief description of the Figures

Figure 1. Arginine prevents thermal induced coagulation of plasma proteins

A: the skeletal formula of arginine. B: The effect of L-, D- and L/D-arginine on plasma coagulation.

Figure 2. Tolerance of PCR to L-arginine

The effect of different L-arginine concentrations on PCR. Two replicates were performed for each concentration per PCR run and a water only control was also included.

Figure 3. The effects of PCR component on plasma coagulation

A: The effect of PCR reagents on coagulation of plasma diluted 1 :3 or 1 :4. B: The effect of MgCI ₂ (1-3mM), KCI, Tris (pH 8.5) and BSA on plasma coagulation. C: The effect of different combinations of PCR reagents on plasma coagulation: MgCI ₂ + KCI; MgCI ₂ + Tris (pH 8.5); MgCI ₂ + BSA; KCI + Tris, KCI +BSA, Tris (pH 8.5) + BSA.

Figure 4. Optimisation of L-arginine Concentration

The effect of different concentrations of L-arginine (0.625-5mg/ml) on the coagulation of plasma diluted 1 :3. Figure 5. Final reagent mix testing on plasma and serum

The coagulation of plasma or serum (neat or diluted 1 :2 or 1 :3), with or without supplementation with the optimized anticoagulant reagents (5mg/ml L-arg, 50mM Tris, 5mM MgCI ₂ ).

Definitions

Anticoagulant

an agent that reduces or prevents coagulation of a sample, including but not restricted to agents suitable for preventing blood clots. See also Coagulation. Arginine

amino acid having the chemical formula C ₆ H ₁₄ N ₄ 0 ₂ (M _r = 174.20 g mol ^"1 ), also known as 2-Amino-5-guanidinopentanoic acid, Arg or R. Figure 1A shows the skeletal formula of arginine. Arginine can exist in a L- or D- chimeric form. Aggregation: see Protein Aggregation

Coagulation

change to a viscous or solid state caused by the change of a solute into an insoluble form or by the flocculation or separation of colloidal or suspended matter, for example the random aggregation of a denatured protein in solution into insoluble aggregates. See also Anticoagulant.

Denaturation

loss-of-function modification to the secondary, tertiary and/or quaternary structure of a protein that results in unfolding of the native protein structure ⁴² . See also Thermal Denaturation. Flocculation

the process in which colloids come out of suspension in the form of floes or flakes. Target nucleic acid

the nucleic acid amplified or replicated by a thermal cycling reaction. In order for a thermal cycling reaction to occur the appropriate nucleic acid target must be present in a sample. The appropriate target will depend on the thermal cycling reaction and the sequences of the primers. The target nucleic acid may be present in for example, digested genomic DNA, viral DNA, ligated DNA, DNA copies of mRNA or viral genomic RNA or a DNA plasmid.

Thermal cycling reaction

a reaction comprising cycles of repeated heating and cooling facilitating nucleic acid melting and enzymatic replication. Thermal cycling reactions may also be referred to as temperature cycling reactions. PCR is an example of a thermal cycling reaction. There are a wide variety of thermal cycling reactions and types of PCR. The reagents necessary are well known in the field, and include a polymerase (e.g. Taq, Tma or Pfu), substrate for the polymerase (e.g. dNTPs) and the appropriate reaction and dilution buffers. Types of thermal cycling reaction include ligation mediated PCR (e.g. inverse PCR (I PCR) ⁴³ and anchored PCR ⁴⁴ ), reverse transcriptase PCR (RT-PCR), quantitative RT-PCR ⁴⁵ , helicase dependent amplification (HAD) ⁴⁶ and rapid amplification of cDNA ends (RACE) ⁴⁷ . Depending on the type of reaction, thermal cycling regents may, for example, reverse transcriptase, DNA ligase, fluorescently labelled probes, helicase or

DNase. See also Target nucleic acid.

Thermal Denaturation

protein unfolding caused by heat. See also Denaturation.

Protein Aggregation

a self-association reaction in which denatured proteins group together to form higher molecular weight complexes (aggregates) ⁴⁸ . Protein aggregation is mediated by interaction between non-polar residues exposed during denaturation ⁴⁹ .

Descri tion

The present invention relates to a method of performing a thermal cycling reaction comprising:

a. mixing a sample with i) an anticoagulant and ii) reagents necessary and sufficient for performing a thermal cycling reaction in the sample in the presence of a target nucleic acid, and

b. incubating the sample under thermal cycling conditions,

wherein the anticoagulant protects the thermal cycling reaction from inhibition by proteins in the sample, particularly denatured proteins in the sample.

The thermal cycling reaction of the method is preferably PCR.

The anticoagulant

In some embodiments the anticoagulant comprises arginine. In further embodiments, the sample is mixed with arginine to give a concentration of 2-6 mg/ml, preferably 5mg/ml. In a still further embodiment the sample is diluted prior to the incubation step such that the concentration of arginine in the sample during the incubation step is 0.5-2mg/ml, preferably 1.7mg/ml. The arginine may be L-arginine, D-arginine or a mixture of D- and L-arginine. The anticoagulant may also be any suitable anti-aggregation agent that prevents inhibition of a thermal cycling reaction by denatured proteins that does not itself inhibit the PCR reaction in the absence of significant dilution of the sample or purification step. The reagents necessary and sufficient for performing a thermal cycling reaction may also comprise the anticoagulant. In one embodiment, the anticoagulant and reagents may be provided in a single solution. The anticoagulant may comprise MgCI ₂ , preferably wherein the sample is mixed with MgCI ₂ to give a MgCI ₂ concentration of 2-6mM, preferably 5mM. The anticoagulant may comprises Tris, preferably Tris (pH 8.5), preferably wherein the sample is mixed with Tris to give a Tris concentration of 30-60mM, preferably 50mM.

The protease and heat inactivation

In the method of the invention the sample may be supplemented with protease. In one embodiment the method of the invention comprises the additional step of mixing the sample with a protease, for example to release nucleic acid from cellular, viral or bacterial structures. The sample may be subjected to protein denaturing conditions, for example to heat inactivate the protease, prior to mixing with the anticoagulant and/or the reagents, preferably wherein subjecting the sample to denaturing conditions comprises heating the sample, preferably to 70- 100°C, more preferably to 90-95°C, most preferably to 95°C. The sample is preferably heated for 1-20 minutes, preferably 5-10 minutes, most preferably for 5 minutes. Where heat inactivation of a protease is required, the denaturing conditions should be sufficient to deactivate the protease. The protease is preferably suitable for digesting a viral capsid, most preferably the Hepatitis capsid such as HCV, in order to release viral genetic material. The protease is preferably a serine protease isolated from a Bacillus strain. Thermal cycler

The method of the invention is suitable for being performed in a conventional thermal cycler. In one embodiment, the thermal cycling reaction is performed in a thermal cycler as described in WO 2012/038750 ⁵⁰ , wherein the cycler comprises a sample block for receiving the sample, a Peltier-type thermoelectric element adjacent the sample block, configured for cooling the sample block, a non-Peltier-type heating device adjacent the sample block, configured for heating the sample block; a heat sink, separated from the sample block and Peltier-type element; and a heat pipe connecting the heat sink to the Peltier-type element, which permits thermal energy to transfer from the Peltier-type element to the heat sink. In some embodiments the sample block is sandwiched between the Peltier-type element and the non-Peltier-type heating device and/or further comprises an optics assembly.

The method of the invention may form part of a diagnostic test as described in WO/2012/093261 ⁵¹ , wherein the diagnostic test uses a reaction vessel having an identification tag (e.g. an RFID tag) readable by a remote reader; and a thermal cycler including a remote reader and means for reading a computer readable medium, the method comprising:

a) reading a readable tag from a reaction vessel, to determine the identity of the vessel; b) comparing the identity of the vessel with data obtained from the computer readable medium representing one or more reaction vessel identities and associated processing steps of a diagnostic test;

c) selecting an appropriate processing step associated with the reaction vessel identity to perform;

d) performing the selected processing step on the reaction vessel; and

e) displaying the result of the performed processing step

wherein the sample for use in the diagnostic test is contained in the reaction vessel.

Sample

The sample used in the present invention may be derived from blood. The sample may comprise serum or plasma. In one embodiment that the sample comprises serum or plasma diluted in water, preferably to a ratio between 1 :2 and 1 :4, most preferably to a ratio of 1 :3. The sample may also be derived from other body fluids or tissues, for example cerebrospinal fluid (CSF), amniotic fluid, bile, mucus, saliva, semen, aqueous humour, lymph, synovial fluid faeces. The sample may be derived from a biopsy.

The sample may be processed or stored prior to use, for example frozen or heated. The sample may be known to contain the nucleic acid target for the thermal cycling reaction, or may be a test sample (wherein it is not known whether the nucleic acid target is present). In some embodiments, the sample may be derived from a cell or tissue culture. The nucleic acid target may be a HCV sequence. The sample may be derived from a patient. The method of the invention may be used to diagnose HCV infection in a patient. Anticoagulant

The present invention also relates to an anticoagulant for use in any of the methods of the invention. In one embodiment the anticoagulant comprises arginine and MgCI ₂ and/or Tris (pH 8.5). The Tris preferably comprises Tris (pH 8.5). The arginine may be L-arginine, D-arginine or a mixture of D- and L-arginine. The anticoagulant may be provided in a solution with reagents suitable for performing a thermal cycling reaction. Reaction mix

The inventors have developed a mixture of reagents that prevent the coagulation of plasma or serum proteins upon heating to 95°C, therefore allowing the direct input into the PCR. The invention can be used as an up-front plasma/serum preparation step for any blood borne diagnostic method. In one embodiment, the present invention relates to a reaction mix comprising the anticoagulant of the invention comprising 5mg/ml L-arginine, 50mM Tris and 5mM MgCI ₂ . The arginine may be L-arginine, D-arginine or a mixture of D- and L-arginine.

Kit

The present invention also relates to a kit comprising a sample tube; reagents necessary and sufficient to perform a thermal cycling reaction; and arginine. Preferably the arginine is provided in the sample tube. The arginine may be L-arginine, D-arginine or a mixture of D- and L- arginine. Preferably, the reagents of the kit are provided in a lyophilised form. In one embodiment the reagents comprise MgCI ₂ and/or Tris, preferably Tris (pH 8.5). The kit may also include instructions for use with the kit. The sample tube may form part of a reaction vessel assembly as described in WO/2012/059751 ⁵² , comprising at least one reaction vessel having a mouth, a body, and a tip; and a casing defining a cavity having an opening, the casing further having an engaging surface; wherein in a first configuration the reaction vessel is received within the cavity of the casing via the opening, and in a second configuration the engaging surface of the casing engages with the mouth of the reaction vessel to close the mouth.

In another embodiment of the invention, the thermal cycling reaction for which the reagents are necessary and sufficient is PCR. The kit may also comprise a protease, for example Protease K or Protease. The protease is preferably suitable for digesting a viral capsid, most preferably the HCV capsid, in order to release viral genetic material. The protease is preferably a serine protease isolated from a Bacillus strain. The protease is preferably provided in the sample tube and or provided in a lyophilised form.

EXAMPLES

1.1. Introduction

The invention was initially developed for use in conjunction with the Genedrive Hepatitis C Kit. The Genedrive Hepatitis C Assay requires the use of a proteolytic enzyme (Protease) to aid in the release of the RNA target by digestion of the viral particles. Temperatures of 95°C are required for the denaturation of the enzyme prior to the reverse transcription phase of PCR. Consequently, without the presence of any preventative reagents plasma protein thermal coagulation occurs. In order to avoid introducing additional processing steps, it was investigated whether an anti-aggregation agent could prevent coagulation of the samples at concentrations insufficient to inhibit a subsequent thermal cycling reaction.

1.2. Materials and Methods

1.2.1. Protease digestion in the presence of arginine

Plasma samples were initially diluted 1 :3 in water prior to proteolytic digestion with 2mg/ml of Protease (Qiagen; product number 19157). The protease is a serine protease isolated from a recombinant Bacillus strain. The samples were incubated at 37°C for 15 minutes and then heated to 95°C for 5 minutes. The samples were then pelleted to visualise the coagulation effects. To assess the effects of arginine on thermal coagulation, the samples were supplemented with arginine variants, L-, D- and a mixture of L- and D- (DL) with a final working concentration of 10mg/ml. The controls consisted of digested plasma with water only or with PCR reagents (Ready To Go beads, GE Healthcare) to mimic standard PCR conditions.

1.2.2. PCR tolerance of arginine

Details of the HCV Genedrive PCR assay have been previously described ⁵³ . The PCR was performed in the presence of L-arginine at a final concentration of 5mg/ml (28.7mM), 2.5mg/ml (14.4mM), 1.25mg/ml (7.18mM), and 0.625mg/ml (3.58mM). Two replicates were performed for each concentration, per PCR run. A water only control was also included.

1.2.3. Minimal arginine concentration required in combination with MgCI ₂ and Tris (pH8.5)

The plasma was pre-diluted 1 :3 in water, supplemented with 2mg/ml Protease, 2.5mM MgCI ₂ , and 12.5mM Tris (pH8.5), together with varying concentrations of L-arginine: 5mg/ml (28.7mM), 2.5mg/ml (14.4mM), 1.25mg/ml (7.18mM), and 0.625mg/ml (3.58mM). The plasma was incubated for 10 minutes at 37°C, followed by denaturation at 95°C for 10 minutes, then pelleted to visualise the coagulation effects.

1.2.4. The effect of anticoagulation agents on plasma and serum samples

Plasma and serum samples were tested either neat, or diluted 1 :2, or 1 :3 in water prior to supplementation with and without the anticoagulant. All samples were Protease treated (2mg/ml), incubated at 37°C for 10 minutes, and denatured at 95°C for 10 minutes, then pelleted to visualise the coagulation effects.

1.3. Results

1.3.1. Arginine prevents the coagulation of plasma proteins

The effect of arginine on the coagulation of plasma was assessed. Plasma samples heated to 95°C following proteolytic digestions did not coagulate when heated in the presence of any of the arginine chimeric variants (L-, D- and a mixture of L- and D- (DL)). The control samples formed a solid gelatinous mass (Figure 1 B). These data demonstrated that all of the arginine variants prevent thermal coagulation of plasma proteins. 1.3.2. PCR tolerance to arginine

To identify the tolerance levels of L-arginine on PCR, a model Genedrive® assay was subjected to supplementation with differing concentrations of L-arginine. The PCR was shown to tolerate L-arginine concentrations of at least 1.25 mg/ml (Figure 2). Surprisingly, it was observed that the PCR reagent (arginine negative) control sample also had reduced coagulation compared to the water only sample (Figure 3A). This effect was only observed when the plasma sample was diluted 1 :4.

1.3.3. MgCI ₂ and Tris (pH 8.5) prevent the coagulation of plasma proteins

The individual PCR components of the PCR reagent sample responsible for preventing coagulation were identified as MgCI ₂ and Tris (pH 8.5) (Figure 3B). A 2mM concentration of MgCI ₂ was sufficient to prevent thermal coagulation. KCI and BSA in isolation did not prevent thermal coagulation. The anti-coagulation effect of MgCI ₂ and Tris (pH 8.5) was synergistic (Figure 3C).

1.3.4. MgCI ₂ and Tris (pH 8.5) prevent the coagulation of plasma and serum proteins

The minimal L-arginine concentration required to prevent thermal induced plasma protein coagulation in a sample containing MgCI ₂ and Tris (pH8.5) reagents was investigated. The highest concentration of L-arginine (5mg/ml) tested had the greatest effect on preventing plasma protein coagulation (Figure 4). During a standard PCR workflow, the protease treated plasma is further diluted 3 fold with the RT-PCR reagents. An initial L-arginine concentration of 5mg/ml in the plasma is thus diluted to a final working concentration of 1 .7mg/ml. This concentration is tolerated by a PCR (Figure 2). The working concentrations of MgCI ₂ and Tris (pH 8.5) required to prevent thermal induced protein were optimized, and are represented in Table 2.

Table 2: Final Reagent Formulation

The optimized formulation of anti-thermal coagulation formulation was also shown to prevent thermal coagulation of serum samples (Figure 5).

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